Restoring patient wellness. Building physician practices.

Pituitary Tumors

Signs and Symptoms
Since the pituitary gland controls the production of hormones throughout the body, pituitary disorders have a broad range of symptoms. Symptoms depend on the type and location of the tumor and whether the tumor causes hormone excess, hormone deficiency, or pressure on the brain and central nervous system. Thus, one type of pituitary tumor may produce symptoms that are very different from those produced by another type of growth. In addition, some tumors may begin by causing the release of excess hormone and then later result in a hormonal deficiency as normal pituitary cells are suppressed, thereby confounding a proper diagnosis.
Common symptoms of all pituitary tumors as listed below, followed by typical symptoms for the various types of tumors.

All Pituitary Tumors

• Headache
• Decreased libido
• Menstrual disorders
• Cold intolerance
• Excessive perspiration
• Decreased appetite
• Vision impairment, blurriness, blindness (particularly poor peripheral vision)
• Excessive thirst and frequent urination
• Growth failure
• Delayed or premature puberty
• Nausea
• Dry skin
• Constipation
• Fatigue
• Low or high blood pressure
• Hypernatremia (high sodium in the blood)
• Frequent urination (diabetes insipidus)

  Prolactinoma

• Infertility
• Amenorrhea
• Oligomenorrhea (irregular/sparse menstruation)
• Decreased libido
• Galactorrhea (breast milk production/leakage/nipple discharge)
• Osteoporosis, bone fractures, breakage
• Impotence vaginal dryness (painful intercourse)
• Visual loss

  Growth Hormone-secreting Adenoma

• Sleep apnea
• Hand, foot, face, or tongue growth or enlargement
• Swelling (soft tissue enlargement)
• Coarsening of facial features
• Change in ring or shoe size
• Spreading teeth, bite difficulties (overbite/underbite)
• Bell’s palsy (facial paralysis on one side)
• Carpal tunnel syndrome
• Joint and bone aches, pains, and tenderness (including foot and tooth pain)
• Gigantism
• Excessive perspiration
• Oily skin
• Impotence

  Cushing’s Disease (ACTH secreting adenoma)

• Fat build-up in the face (round or moon face), back (characteristically the upper back causing a so-called hump), and chest, while the arms and legs to become relatively thin
• Hyperglycemia/diabetes
• Weak and fragile muscles and bones
• Backache
• Flushed face
• Thin skin
• Increased bruising or bruisability
• Skin ulcers
• Hypertension
• Weight gain
• Skin striae (lines/wrinkles/stretch marks)
• Decreased fertility in men
• Mood swings
• Excess hair growth
• Osteoporosis rib and vertebral compression fractures

  (TSH) Thyrotropin-secreting Adenomas

• Weight loss
• Increased appetite
• Heart palpitations or irregular heartbeat (superventricular tachycardia, atrial fibrillation)
• Tachycardia
• Heat intolerance and increased sweating
• Tremor
• Frequent bowel movements
• Fatigue and muscle weakness
• Exertional intolerance and shortness of breath
• Oligomenorrhea (decreased menstrual flow)
• Nervousness and irritability
• Other mental disturbances
• Sleep disturbances (including insomnia)
• Changes in vision, photophobia, eye irritation, diplopia, or exophthalmos
• Lower extremity edema
• Sudden paralysis
• Impaired fertility

  Medical History [B]
  q While making a diagnosis, the physician needs to find out if family members have had pituitary gland tumors, hyperparathyroidism (overactive parathyroid gland), multiple kidney stones, multiple stomach ulcers, hypoglycemia (low blood sugar), or adrenal gland tumors.
  q Molecular biology studies have shown that a change in the DNA of pituitary cells can cause unregulated growth of a particular cell type, resulting in a pituitary tumor.
  q Multiple Endocrine Neoplasia, Type I, an uncommon type of pituitary tumor, is inherited. There is usually a family history of endocrine tumors, most commonly a parathyroid tumor, a pituitary tumor, and, less commonly, a tumor of the pancreas. This occurs in less than 4% of patients with a pituitary tumor.

  Laboratory Tests [B]
  A variety of approaches are necessary to diagnose pituitary dysfunction. Even so, there are limitations because the hormones being tested for are present in very small quantities, they are often released cyclically, based on circadian rhythms, they are pulsatile, and many factors can interfere with their release patterns, such as exercise, stress, and fluctuating levels of serum binding proteins.

  Hormone Tests

• Serum hormone testing can be done on the end organ or on the anterior pituitary hormones directly.
• End organ tests may include thyroid hormones (fT4, fT3, and rT3), adrenal hormones (cortisol, DHEA), sex hormones – estrogens (E1,E2,E3), progesterone, and testosterone.
• Anterior pituitary hormone tests include TSH, ACTH, FSH, LH, GH, PRL, and ADH.

  Suppression Tests
  The suppression test is used when a pituitary hormone is thought to be in excess. The principle of a suppression test takes advantage of normal negative feedback control of hormone secretions. A normal response to an exogenously administered drug or hormone is to “suppress” the gland’s secretion. For example, dexamethasone normally suppresses ACTH production by the pituitary. Failure of the gland to respond or “suppress” constitutes an abnormal response. Another example of a pituitary suppression test is to give oral glucose and to observe serum GH response. A normal response is to suppress growth hormone after glucose ingestion. Suppression tests are available for most of the pituitary hormones, but should only be performed under certain circumstances. Suppression tests are particularly useful to detect hormone-producing tumors that are not responding to feedback control.

  Stimulation Tests
  A stimulation test is usually performed when a deficiency of a pituitary hormone is suspected. Since many pituitary hormones are produced episodically and random sampling in blood may give a low value in between normal episodic release, a stimulation test is required to test the ability of the pituitary to release a specific hormone. An example of a pituitary stimulation test is the use of arginine to release GH in patients with suspected growth hormone deficiency. A rise in blood growth hormone is an expected normal response to arginine infusion; failure to respond is abnormal and proves the inability of the pituitary to release this hormone normally.

  Imaging Studies
  A computerized tomography (CT) or magnetic resonance imaging (MRI) scan of the brain can often detect a pituitary tumor. In children, an X-ray of the hand and wrist can measure whether bone growth is normal.

  Therapeutics
  In general, dopamine agonists need to be taken for life, and about 20% of patients might completely resolve after 5 years. With the use of dopamine agonists, prolactin levels will decrease and women can get pregnant. The use of the naturopathic treatments listed for hyperprolactinemia can be used as primary treatments for prolactinomas. If prolactin levels do not go down, bromocriptine should be considered.

  Prognosis
  Most studies indicate that prolactinomas rarely progress. Less than 5% of prolactinomas enlarge. Some patients do have spontaneous remission.